两种内镜下微创术式治疗早期食管癌及癌前病变的疗效及其与术后延迟性出血的相关性分析-现代医学

两种内镜下微创术式治疗早期食管癌及癌前病变的疗效及其与术后延迟性出血的相关性分析

单位：三峡大学附属仁和医院消化内科, 湖北宜昌 443001

分类号：R735.1

出版年·卷·期（页码）：2020·39·第四期（488-491）

摘要：

目的：探讨两种内镜下微创术式治疗早期食管癌及癌前病变的疗效及与术后延迟性出血的相关性分析。方法：选取我院收治的120例早期食管癌及癌前病变的患者，依照手术治疗方式的不同分为研究组与对照组两组（各60例），研究组采用内镜下黏膜剥离术（ESD），对照组采用内镜下黏膜切除术（EMR），比较两组患者围术期相关指标及临床疗效等差异。结果：研究组患者手术时间较对照组长，但住院时间、治疗费用、1年复发率及术后并发症发生率均低于对照组，差异均有统计学意义（P<0.05）；研究组患者病变直径>3 cm及 ≤ 3 cm的切缘阳性率均显著低于对照组患者（P<0.05）；两组患者性别、病灶位置、手术方式及术中出血比较差异无统计学意义（P>0.05），而年龄、病灶大小及浸润深度比较差异有统计学意义（P<0.05）；浸润深度是影响患者术后延迟性出血的独立危险因素（P<0.05）。结论：ESD较EMR在治疗早期食管癌方面疗效更为显著，并可改善患者预后及提高肿瘤完整切除率，同时临床医生在内镜治疗早期食管癌及癌前病变的过程中，对于病灶浸润较深的患者应多加关注，以防患者术后出现延迟性出血。

Objective: To evaluate the efficacy of two minimally invasive endoscopic surgery for early esophageal cancer and precancerous lesions and their correlation with delayed postoperative bleeding. Methods: 120 patients with early esophageal cancer and precancerous lesions in our hospital were divided into the study group and the control group (60 cases in each group) according to the different surgical treatment methods. The study group adopted the endoscopic submucosal dissection(ESD) method and the control group using the endoscopic mucosal resection(EMR) method, and the perioperative related indexes and clinical curative effect were compared betweenthe two groups.Results: The operation time of the patients in the study group was longer than that of the control group, but the time of hospitalization, the cost of treatment, the recurrence rate of 1 years and the incidence of postoperative complications were all lower than those in the control group (P<0.05), and the positive rates of the lesion diameter >3 cm or ≤ 3 cm in the study group were significantly lower than those in the control group (P<0.05). There were no statistically significant differences in sex, location of the focus, mode of operation and intraoperative bleeding between the two groups(P>0.05), but there were significant differences in age, size and depth of invasion (P<0.05), and the depth of infiltration was an independent risk factor for delayed bleeding after operation (P<0.05).Conclusion: ESD is more effective than EMR in the treatment of early esophageal cancer, and it can improve the prognosis and complete tumor resection rate. At the same time, clinicians should pay more attention to patients with deeper infiltration of the lesions in the process of endoscopic treatment of early esophageal and precancerous lesions, so as to prevent the postoperative delayed bleeding.

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